Cholecystectomy is the surgical removal of the gallbladder. Surgical options include open cholecystectomy and LC. A traditional open cholecystectomy involves removal of the gallbladder through a large open incision to the abdomen, thus sometimes requiring a lengthy recovery time for a patient. A traditional open cholecystectomy will also leave a subcostal scar on the patient due to the large incision required.
LC has mainly supplanted open cholecystectomies as the preferred surgical method for removing gallbladders. A LC typically involves making several small incisions in the abdomen to create various operating ports for the insertion of instruments such as small cylindrical tubes (for the insertion of the retractor) and a video camera for monitoring the surgery. The video camera illuminates the surgical field and sends a magnified image from inside the abdomen to a video monitor, giving the surgeon a close-up view of the gallbladder and surrounding tissues. This allows the surgeon to finely control the surgical instruments inserted into the patient.
To perform LC, a patient is placed on the operating table and anesthetized. Then, using a Veress needle or Hasson technique, the abdominal cavity is entered. The surgeon inflates the abdominal cavity with carbon dioxide or other inert gas to create a working space. The video camera is placed through the umbilical port and the abdominal cavity is inspected. A first retractor is inserted through a first port and the fundus is retracted cephalad. A second retractor, inserted through a second port, is used to retract the infundibulum laterally (as shown in FIG. 1). This allows the cystic duct and cystic artery to be identified through the video camera and be dissected using a dissector. Next, the gallbladder is dissected away from the liver bed and removed through one of the ports. For a detailed example of LC using two graspers see U.S. Pat. No. 5,496,310, the contents of which are incorporated by reference in their entirety.
Recently, LC has been performed through a single incision via the patient's umbilicus as the only incision. This advanced technique is called Laparoendoscopic Single Site Surgery (LESS). However, LESS requires that the video camera, dissector, and two retractors all be inserted through the single incision in the patient's umbilicus. The need for four instruments all vying for space and mobility through the one incision at the umbilicus is too unwieldy. Therefore, a need clearly exists for a single instrument capable of performing the function(s) of the two separate retractors.